By IDSE News Staff
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally, posing a particularly significant threat to people living with HIV. To address this, CVD prevention plans rely on prediction models like atherosclerotic cardiovascular disease (ASCVD) risk scores to estimate the risk for heart disease.
However, previous studies have questioned whether these common prediction models perform well among people with HIV, and there remains a gap in understanding what these scores mean for those who live in low- and middle-income countries (LMICs).
Researchers from Massachusetts General Hospital with an international team of investigators conducted a study to evaluate how well existing ASCVD risk estimates could be used to predict CVD outcomes in global populations with HIV (Lancet HIV 2025;12[2]:E118-E129).
Their prospective cohort study used data from the REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) trial to analyze people with HIV who lived in low-, middle- and high-income countries across several continents.
Between March 2015 and July 2019, they recruited 3,893 participants between 45 and 55 years of age. There were 2,684 men and 1,209 women, with most of the participants (1,643) being Black. Whites (1,346) and Asians (566) also participated. Three hundred thirty eight identified as other race.
The researchers found that for those in REPRIEVE, current risk models underestimated CVD events in both women and Black men in high-income countries (HICs), while overestimating CVD events for all people with HIV in LMICs.
“When restricted to high-income countries, we found underprediction (OE [observed to effected] event ratio >1.0) among women (2.39) and Black or African American participants (1·64),” the researchers wrote.
“These findings allow researchers to fine-tune cardiovascular disease prediction models for people living with HIV,” said Patrice Desvigne-Nickens, MD, a medical officer within the National Heart, Lung, and Blood Institute. “Assessing the accuracy of these predictions in subgroups of the population is possible because of carefully developed outreach and enrolling a diverse study population—representing all people at risk.”
The researchers improved the calibration of the pooled cohort equation risk score among those who lived in HICs by multiplying the original score by 2.8 in Black women, 2.6 in women who were not Black and 1.25 in Black men.
“This study underscores the need for nuanced, region-specific and population-specific CVD prediction models that accurately reflect cardiovascular risk for PWH [people living with HIV], including those living in LMICs,” explained Steven Grinspoon, MD, a co-lead study author and the chief of the metabolism unit, Endocrinology Division of the Department of Medicine, at Massachusetts General Hospital, in Boston.
Markella Zanni, MD, a co-lead study author and the director of women’s health research in the metabolism unit at Massachusetts General Hospital, said future work is needed to validate these corrected values. “We anticipate that experts on guideline committees will recognize our findings and may consider stronger treatment recommendations for women and Black or African American men living with HIV in HICs,” Dr. Zanni said.
